Provider Demographics
NPI:1659935351
Name:JARNAGIN, JOHNNY SHELDON JR (MD)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:SHELDON
Last Name:JARNAGIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 YALE ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-6029
Mailing Address - Country:US
Mailing Address - Phone:978-420-9338
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:978-420-9338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-28
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1016958208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation